Examining the Feasibility and Effectiveness of Online Acceptance and Commitment Therapy Self-Help in a Quasi-Stepped Care Model: A Pilot Study

Impact Statement This study examined the utility of offering clients on a clinic waitlist an eight-session online self-help program before starting in-person therapy. Although most participants experienced significant gains in the majority of outcomes assessed, we observed relatively high attrition, suggesting that strategies to increase user engagement with the online program are needed. The global burden of mental illness and limited resources make increasing the efficiency of available mental healthcare resources especially crucial. One way this can be done is a stepped care approach to treatment. To test the viability of using internet-based self-help in a stepped care model, we examined the feasibility, acceptability, and effectiveness of an online self-help acceptance and commitment (ACT) program prior to starting in-person therapy at a university community clinic (N = 51). Online program acceptability was at least moderate. There was clinically significant change in 75.9%-79.3% and reliable change in 31.0%-100% of our sample on three of four outcomes of interest (e.g., symptom impairment) after the online program. In addition, 60%-100% reliably improved from the online program as well as from subsequent treatment on three of four outcomes, indicating that most of our sample progressed through the steps of care effectively and benefited from the quasi-stepped care approach. Scores also indicated positive overall effects of the online program and in-person therapy. Our findings tentatively support the use of low-intensity resources like online self-help programs to reduce therapist burden in outpatient clinics by initiating client progress before intake. Limitation to this approach and the study are discussed.